Welcome to Optometry Simplified.
In this weekly newsletter, I've curated the best resources to help you grow personally and professionally.
My mission is to find what's best for my patients and my practice.
Here's what I've found...
Links I Liked
When fellow optometrists write books, let's read them.
Regardless of practice type, both offer real value to the modern OD. Pick up Kurt Steele, OD's We're Not Selling, We're Winning to learn how he grew a struggling small town practice from $280K to over $4 million, not by working more, but by building a strong team culture. Then grab David Kading, OD's The Invisible Team, because the thing quietly strangling your practice isn't your clinical skills or your schedule, it's the administrative chaos your patients never see, and Dr. Kading shows you exactly how to fix it.
I've never read this much about pinguecula.
And it was worth it. Christine Sindt, OD, wrote a comprehensive review of ocular pinguecula and how to effectively manage these common conjunctival lesions. Review of Cornea and Contact Lenses
Protecting your practice starts with understanding your biggest risks.
PPP Practice Risk Assessment helps identify potential compliance, billing, HR, and operational gaps that could be impacting your growth and profitability — before they become bigger problems.
Research I'm Reading
Diabetic retinopathy = increased glaucoma risk.
This retrospective study of nearly 6 million patients found that diabetics with retinopathy carry a 2.6 to nearly 5-fold increased lifetime risk of developing ocular hypertension or POAG, depending on diabetes type. Journal of Glaucoma
Deep Thoughts
Last week's piece on the value of the comprehensive diabetes evaluation generated more responses than almost anything I've written this year.
Good timing, then, to add another layer.
You've likely heard about the association between GLP-1 receptor agonists semaglutide, tirzepatide, liraglutide and others and NAION. I've mentioned it several times in previous editions here.
The signal emerged from a 2024 retrospective study out of a tertiary neuro-ophthalmology center and has since generated a ton of follow-up research.
Some studies show a two-to-four-fold increased risk. Others show no association at all. One found a positive effect. The science is far from settled, and anyone telling you otherwise isn't reading carefully.
What I've found interesting and pertinent to those of us in primary eye care is how the major organizations have responded.
In 2025, the European Medicines Agency concluded that NAION is a very rare side effect of semaglutide and recommended that semaglutide be discontinued if NAION is confirmed. That recommendation was then reiterated by the WHO which then issued a global safety alert shortly after.
The AOA published their clinical report around the same time. They documented the EMA's recommendation faithfully. What they did not do is endorse it. Their own clinical recommendations make no mention of discontinuation. They focused instead on baseline dilated exams, careful documentation, closer follow-up intervals, and collaborative care with the broader medical team.
Then, just this month, NANOS and the AAO published a joint consensus statement that addressed the EMA's recommendation directly.
Their conclusion was measured but clear: they do not support a generalized recommendation to discontinue GLP-1 therapy when NAION occurs.
Discontinuing a medication that may be managing diabetes, reducing cardiovascular risk, or treating obesity carries its own serious consequences. The decision, they argued, belongs to a shared conversation between the patient and their full care team weighing individual risk factors, systemic benefits, and available alternatives.
This is a tension worth managing rather than solving. The evidence doesn't yet support a clean, universal answer on discontinuation, and the AAO/NANOS document is right to resist one. The AOA, by acknowledging the EMA's position without adopting it, arrived at essentially the same place from a different direction.
So what should we be doing in our exam lanes as optometrists?
What all parties agree on is what should happen. The AOA said it plainly, and it deserves to be quoted directly:
"Annual in-person, comprehensive, dilated eye examinations are more important than ever. Improved patient discussion associated with common systemic disease risk factors such as diabetes, hyperlipidemia, hypertension and others need to occur in greater detail and frequency with patients on or considering GLP-1RAs."
That's the action item. Not a verdict on NAION causation. Not a protocol for discontinuing someone's Ozempic. Those decisions belong to those who know the full picture of each patient's health.
What involves you is this: knowing which of your patients are on GLP-1s, documenting their optic nerve at baseline, and having a real conversation about systemic risk.
Which brings me back to last week's question, which now I'll make it a little more pointed.
If we've established that the diabetes patient requires baseline documentation, individualized risk counseling, closer follow-up intervals, and coordination with their broader care team, I'd genuinely like to know: do we still think that care can be delivered inside a managed vision care wellness screening?
Can you do me a favor? If you found any of these resources helpful, share this newsletter with one of our colleagues!
See you next week!
--Kyle Klute, OD, FAAO